Advanced therapy in thoracic surgery by Kenneth L. Franco M.D., Joe Putnam M.D.

By Kenneth L. Franco M.D., Joe Putnam M.D.

This paintings provides cutting-edge concepts in thoracic surgical procedure from the investigators who've constructed them. all of the succinct chapters represents the non-public remedy protocols of prime specialists. The complicated treatment suggestion is legendary for conveying healing info in an effective, quick-review type. This authoritative name presents entry to specialist session at the hardest demanding situations dealing with thoracic surgeons this present day. New chapters to this moment variation contain: New suggestions to control soreness; Advances in Diagnostic Imaging; administration of Germ phone Tumors of the Mediastinum, Updates on Diaphragmatic Pacing; and Preoperative evaluate of Neuro-Motor ailments of the Esophagus.

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The line itself in this particular example depicts the equation NSAID + PPI = COX-2 – $102. In other words, the two treatment strategies yield identical outcomes, as long as the combined drug costs for NSAID plus PPI cost $102 less than the COX-2 costs alone. Where does the $102 come from? Inspection of the original decision tree reveals that the $102 value stems from the 10% probability for the overall occurrence of complications multiplied by their respective expected value of $1,020. To reach equivalence between COX-2 and NSAID plus PPI, the NSAID plus PPI strategy needs to be cheaper by at least $102 to compensate for the additional costs of potential ulcer complications.

Any acute ulcer can go in two directions: It can heal or it can stay acute. Similarly, any healed ulcer can become acute again or stay healed. The natural history of PUD can, therefore, be conceptualized as ongoing transitions between two health states (ie, acute and healed peptic ulcer). All that one needs to know to be able to set up the Markov model are the healing rate (HR) of acute ulcers and the relapse rate (RR) of healed ulcers. For the model of Figure 2-6, it was assumed that during a 1-month time period 40% of all acute ulcers would heal spontaneously and 8% would relapse.

Although the chain is stopped after 4 months, it could have been continued for an endless time. This type of drawing provides an intuitive explanation for why the analysis is referred to as a “chain,” and it also allows the model to be transformed directly into a spreadsheet calculation. From a mathematical perspective, however, all the relevant information necessary to calculate the chain outcome is already contained in the transitions drawn for the first month only. Frequently, this relevant information can be condensed into a short form of a Markov chain, as shown in the upper drawing of Figure 2-7.

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